rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-164-172rsp-3019Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHПоражение печени у больных системной красной волчанкойLiver involvement in patients with systemic lupus erythematosushttps://orcid.org/0000-0002-1728-5749ПановаА. П.PanovaA. P.

Панова Александра Павловна

119991, Москва, Ленинские горы, 1

Aleksandra P. Panova

119991, Moscow, Leninskie Gory, 1

panova.ap@yandex.ruhttps://orcid.org/0000-0001-7901-6635АвдеевВ. Г.AvdeevV. G.

119991, Москва, Ленинские горы, 1

Vladimir G. Avdeev

119991, Moscow, Leninskie Gory, 1

https://orcid.org/0000-0001-6175-1076КрасноваТ. Н.KrasnovaT. N.

119991, Москва, Ленинские горы, 1119991, Москва, ул. Трубецкая, 8, стр. 2

Tatiana N. Krasnova

119991, Moscow, Leninskie Gory, 1119991, Moscow, Trubetskaya str., 8, building 2

https://orcid.org/0000-0002-7939-1416РозинаТ. П.RozinaT. P.

119991, Москва, Ленинские горы, 1119991, Москва, ул. Трубецкая, 8, стр. 2

Teona P. Rozina

119991, Moscow, Leninskie Gory, 1119991, Moscow, Trubetskaya str., 8, building 2

https://orcid.org/0000-0001-7693-5281ПавликоваЕ. П.PavlikovaE. P.

119991, Москва, Ленинские горы, 1

Elena P. Pavlikova

119991, Moscow, Leninskie Gory, 1

https://orcid.org/0000-0002-7542-8189ГеоргиноваО. А.GeorginovaO. A.

119991, Москва, Ленинские горы, 1

Olga A. Georginova

119991, Moscow, Leninskie Gory, 1

https://orcid.org/0000-0002-1530-3464ФилатоваА. Л.FilatovaA. L.

119991, Москва, Ленинские горы, 1119991, Москва, ул. Трубецкая, 8, стр. 2

Anna L. Filatova

119991, Moscow, Leninskie Gory, 1119991, Moscow, Trubetskaya str., 8, building 2

https://orcid.org/0000-0002-2216-0326БорисовЕ. Н.BorisovE. N.

119991, Москва, Ленинские горы, 1

Evgeniy N. Borisov

119991, Moscow, Leninskie Gory, 1

https://orcid.org/0000-0003-0148-5655НовиковП. И.NovikovP. I.

119991, Москва, ул. Трубецкая, 8, стр. 2

Pavel I. Novikov

119991, Moscow, Trubetskaya str., 8, building 2

ФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова»РоссияLomonosov Moscow State UniversityRussian FederationФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова»; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияLomonosov Moscow State University; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian Federation202111052021592164172Copyright © Панова А.П., Авдеев В.Г., Краснова Т.Н., Розина Т.П., Павликова Е.П., Георгинова О.А., Филатова А.Л., Борисов Е.Н., Новиков П.И., 20212021Панова А.П., Авдеев В.Г., Краснова Т.Н., Розина Т.П., Павликова Е.П., Георгинова О.А., Филатова А.Л., Борисов Е.Н., Новиков П.И.Panova A.P., Avdeev V.G., Krasnova T.N., Rozina T.P., Pavlikova E.P., Georginova O.A., Filatova A.L., Borisov E.N., Novikov P.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3019

Поражение печени у больных системной красной волчанкой (СКВ) встречается часто и в большинстве случаев протекает бессимптомно, что затрудняет своевременную диагностику. Вместе с тем уточнение его причин имеет важное значение для определения лечебной тактики и прогноза заболевания.Цель исследования – охарактеризовать особенности поражения печени у больных СКВ и выявить наиболее значимые клинико-лабораторные параметры для дифференциального диагноза волчаночного гепатита. Материалы и методы. В исследование включены 313 больных СКВ, наблюдавшихся в Клинике ревматологии, внутренних и профессиональных болезней имени Е. М. Тареева ФГБУ Первого МГМУ им. И. М. Сеченова (Сеченовский Университет) в период с 2001 по 2019 г. Диагноз СКВ был верифицирован на основании критериев Американской коллегии ревматологов (1997 г.). Обследование всех пациентов включало общий, биохимический, иммунологический анализы крови и ультразвуковое исследование органов брюшной полости. У 13 пациентов было выполнено исследование профиля печеночных аутоантител (ASMA, anti-LKM-1, LC-1, SLA-LP, AMA-M2), у 4 – магнитно-резонансная холангиопанкреатография, у 6 – биопсия печени.Результаты. Признаки поражения печени у больных СКВ были представлены повышением активности ферментов цитолиза и/или холестаза в 58 (18,5%) случаях. У 4 (1,3%) больных диагностирован хронический вирусный гепатит С. Диагноз лекарственного гепатита был установлен у 17 (5,4%) пациентов. Аутоиммунные заболевания печени были выявлены у 2 (0,6%) больных. У 2 (0,6%) пациентов поражение печени было связано с тромботической микроангиопатией (при атипичном гемолитико-уремическом синдроме, наследственной тромбофилии). В 15 (4,8%) случаях наиболее вероятным был диагноз неалкогольной жировой болезни печени. Волчаночный гепатит был наиболее вероятной причиной поражения печени у 18 (5,7%) больных.Выводы. Для проведения дифференциального диагноза при выявлении признаков поражения печени у больных СКВ требуется оценка факторов риска развития различных заболеваний печени, возраста пациентов, давности и уровня повышения активности ферментов цитолиза и/или холестаза, степени активности СКВ, наличия ультразвуковых признаков стеатоза печени и вторичного антифосфолипидного синдрома.

Liver involvement in systemic lupus erythematosus is common and in most cases clinical course is asymptomatic, that makes diagnosis difficult. Determination of the cause of the liver involvement is important to select treatment and to evaluate the prognosis of the disease.The aim of the research was to characterize the clinical features of liver involvement in patients with systemic lupus erythematosus and identify the most significant clinical and laboratory parameters for the differential diagnosis of lupus hepatitis.Materials and methods. The study included 313 patients with systemic lupus erythematosus observed in the E.M. Tareev Clinic of Rheumatology, Internal Medicine and Occupational Diseases of I.M. Sechenov First Moscow State Medical University (Sechenov University) in the period from 2001 to 2019. The verification of diagnosis of systemic lupus erythematosus was based on the criteria of the American College of Rheumatology (1997). Patients examination included complete blood count, biochemical and immunological blood tests and an abdominal ultrasonography. In 13 cases hepatic autoantibodies (ASMA, anti-LKM-1, LC-1, SLA-LP, AMA-M2) were analyzed, in 4 – magnetic resonance cholangiopancreatography and in 6 – liver biopsy were made.Results. Liver involvement were represented by an increase of liver enzymes in 58 (18.5%) cases. Chronic viral hepatitis C was diagnosed in 4 (1.3%) patients. Drug-induced hepatitis was found in 17 (5.4%) patients. Autoimmune liver diseases occured in 2 (0.6%) patients. In 2 (0.6%) patients, liver damage was associated with thrombotic microangiopathy (atypical hemolytic uremic syndrome, hereditary thrombophilia). In 15 (4.8%) cases, the most likely diagnosis was NAFLD. Lupus hepatitis was the most likely cause in 18 (5.7%) patients. Differential diagnosis in cases of liver involvement in patients with systemic lupus erythematosus requires assessment of risk factors for various liver diseases, age of the patients, level of liver enzymes, lupus activity, ultrasound signs of liver steatosis and secondary antiphospholipid syndrome.Determining the cause of the liver involvement for the patients with the systemic lupus erythematosus allows establishing better treatment tactic and improvement of the prognosis.

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The authors declare that there are no conflicts of interest present.